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In-stent chronic total occlusion (CTO) presents various occlusion patterns, which complicate percutaneous coronary intervention (PCI). To investigate the initial outcome and strategy of PCI for in-stent CTO according to the angiographic occlusion patterns. This study assessed 791 in-stent CTOs from the Japanese CTO-PCI Expert Registry from 2015 to 2018. They were divided into 4 patterns Pattern A (n = 419), CTO within the stent segment; pattern B (n = 196), CTO beyond the distal edge; pattern C (n = 85), CTO beyond the proximal edge; a

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